Since the publication of the article by Mixter and Barr, the concepts and concepts of lumbar disc herniation and lumbar disc resection have been accepted by more and more doctors. Love improved the operation method of Mixter in 1938, and took out the intervertebral disc through the intervertebral epidural approach. Now the standard operation method of open surgery is basically the same as that proposed by Ai. Love and Walsh reported 100 cases of discectomy, and put forward recurrent disc herniation for the first time. With the development of microscope technology, Yasargil and Casper published the results of discectomy under microscope in 1977, and then gradually developed into a standard surgical technique.
After 1970s, surgeons began to operate on a large number of patients with disc herniation. People have also begun to find that not all patients with disc herniation are suitable for surgery.
Weber published a prospective study of 10 in 1983, and compared the effects of surgical treatment and non-surgical treatment of lumbar disc herniation. The pain relief of surgical patients is more significant in the short term, but there is no difference in the long-term pain relief rate. After Weber's research, most doctors recommend conservative treatment for 4-8 weeks before operation.
CT was invented by Hounsfield in 1972, and gradually began to be used for spinal examination. The axial image of intervertebral disc can be clearly seen by CT, and the intervertebral disc lesions can be divided into bulging, protruding and prolapse. According to the position, it can be divided into central type, paracentral type and extreme lateral type. CT is helpful for doctors to better determine the site of protrusion and surgical methods, and also deepen their understanding of disc herniation. 1984, Wiesle scanned normal people with CT, and let three radiologists read the film double-blind. It was found that the average asymptomatic population of 19.5% was diagnosed as lumbar disc herniation, and the phenomenon of asymptomatic lumbar disc herniation was first proposed.
MRI was invented in 1980s, and has been widely used in spinal examination since 1990s. Compared with CT, MRI provides clearer imaging of intervertebral disc, nerve and soft tissue. MRI soon became an important examination method for the diagnosis of lumbar disc herniation, and the lack of clear protrusion and compression on MRI became a contraindication for surgery. At the same time, the high resolution of MRI also makes doctors realize that not all MRI manifestations of disc herniation are consistent with the symptoms of patients.
With the improvement of understanding of disc herniation, people have been pursuing a less traumatic method to solve this problem. In 195 1, Hult performed nucleus pulposus removal through anterolateral extraperitoneal approach, and put forward the concept of indirect decompression of spinal canal for the first time.
1973, Kambin used Craig channel to perform percutaneous nucleus pulposus removal without direct vision. In 1975, Hijikata et al. introduced another non-direct percutaneous posterolateral method for nucleotomy. Later, in 1983, Kambin and his colleagues reported that using a working channel with a diameter of 5mm achieved a success rate of 72% in 136 patients.
In order to realize endoscopic surgery and total decompression under direct vision, imaging and irrigation systems need to be added and a larger working channel is needed. Kambin proposed a safety triangle in 1990, with the upper bound being the efferent nerve root, the inner bound being the afferent nerve root and the lower bound being the upper edge of the lower vertebral body. This anatomical safety triangle enables the spinal endoscopic surgery to be further developed on the basis of the original endoscopic discectomy technology, and breaks through the limitations caused by too small instruments. Kambin triangle allows larger instruments and working channels, which enables endoscopic techniques to be applied to the intervertebral foramen area without damaging the nerve roots of the stroke.
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Figure 10 Cambin Triangle
In 1993, Mayer and Brock used an angled endoscope, which can better see the dorsal side of the diseased annulus fibrosus. Mathews reported the intervertebral foramen mirror in 1996 and Ditsworth reported the intervertebral foramen mirror in 1998. In 1996, Kambin and Zhou reported decompression of lumbar nerve roots by cutting off the fibrous ring and decompression of lateral recess stenosis by grasping forceps and circular saw. In 1997, Yeung introduced a complete spinal endoscope system, which is called YESS(Yeung Endoscopic Spinal System). In 2005, Schubert and Hoogland introduced the use of their transforaminal endoscopic technique to remove free intervertebral disc fragments. They used a reamer to remove the ventral part of the superior articular process of the lower vertebral body, thus expanding the intervertebral foramen. Tsou et al. introduced a multi-channel endoscope with a larger working channel in 1997, and Ruetten et al. introduced the endoscope in 2007. More reports about endoscopic direct decompression of intervertebral foramen lesions appeared one after another: Yeung and Tsou in 2002, Ruetten in 2007 and 2008, and Jasper in 20 13.
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Figure 1 1 photos of several inventors and innovators in the field of spinal endoscopic surgery. Female-female: Pavis Cambin, Michael Schubert, Thomas Saugrain, Sebastian Ruten, Anthony Young and Kevin Foley.
These experts have promoted the development of minimally invasive spine surgery, which has reduced the trauma suffered by patients, faster recovery time and less cost. At present, minimally invasive endoscopy is used to treat disc herniation, and there is only a small incision less than 1cm in the skin. You can leave the hospital after the operation on the same day, which was almost unimaginable decades ago.
Looking back on the whole history, mankind has never been able to begin and finally understand that from open surgery to comprehensive minimally invasive treatment, many great doctors and scientists have appeared in this process. However, the struggle against low back and leg pain is far from over, which has brought a heavy burden to individuals and society. The future needs more people to fight for, and tomorrow will be better.